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Purpose: To determine the efficacy and safety of pediatric accelerated cross linking (CXL). Methods: A prospective study on progressive keratoconus (KC) cases under ?18 years of age. Sixty four eyes of thirty nine cases underwent epithelium?off accelerated CXL protocol. Visual acuity (VA), slit?lamp examination, refraction, pentacam reading of keratometry (K), corneal thickness, and thinnest location pachymetry were noted. Cases were followed up on days 1, 5, and at 1st, 3rd, 6th, and 12th?month post procedure. Results: Statistically, significant improvement of the mean aided VA, K, and mean corneal astigmatism (p < 0.0001) was noted. Mean Kmax reading reduced from 55.5 ± 5.64 (47.4–70.4) diopter (D) preoperatively to 54.41 ± 5.51 (46–68.3) D at 12 months postaccelerated CXL. Two cases had progression. Complications encountered were sterile infiltrate and persistent haze. Conclusion: Accelerated CXL is effective and efficacious in pediatric KC.
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Background: Satisfaction is an important element in the evaluation of services rendered by a hospital. Patient satisfaction is as important as other clinical health measures and is a primary means of measuring the effectiveness of health care delivery. It refers to the patient's state of being adequately rewarded. Patient satisfaction is a measure of success of the services being provided by the hospitals. Objective of the study was to assess the satisfaction levels of the people utilizing various services provided in secondary and tertiary health care delivery settings.Methods: Observational hospital based comparative study conducted among Inpatients aged 18 yrs and above from different wards who are discharged during the study period and are willing to participate in the study at Secondary and tertiary health care centres of East Godavari District during May 2015 to April 2016. Sample size was calculated using n-master version 2.0. Sample size calculation was based on assumption that the prevalence of patient satisfaction as 50% with mean difference of satisfaction of 15%, confidence interval of 95%, α - error of 5%, power 90%, with effect size 0.3, sample size estimated was 234 in each setting resulting in a cumulative sample size of 702.Results: It was found that 64.52% of inpatients of District Hospital, Rajahmundry, have expressed neutrality or dissatisfaction regarding overall admission services as compared to 49.14% in Government General Hospital, Kakinada and 14.52% in Area Hospital, Rampachodavaram.Conclusions: The overall patient satisfaction was observed to be around 80% for all the three hospitals.
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Wound healing is type of tissue repair involving number of processes. These processes influenced by both systemic factors and local factors. Nutrition, metabolic status, circulatory status, hormone levels are the main systemic factors which influence wound healing. In addition to these, infection, mechanical factors, foreign bodies, size, location and type of wound are also influence the wound healing process. Various kinds of complications are occurred when wound is not properly healed. In Ayurveda, the term Vrana is equated to wound of modern parlance and the drugs having both Vranashodhana (wound cleansing) and Vranaropana (wound healing) properties play an important role in wound management. Considering this, single and compound formulations having Vranashodhana and Vranaropana properties are compiled from classical texts and compendia. Clinical trials on wound management through are Ayurvedic drugs/regimen reviewed and presented.
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Background: Efficacy of these modalities as shown by various investigations are inconsistent and ambiguous. Thus, evidence based effective treatment option is warranted. Aim of the study was to compare the efficacy of oral ivermectin, topical permethrin and benzyl benzoate in the treatment of uncomplicated scabies.Methods: Patients with confirmed diagnosis of scabies were included in this study. One hundred and ninety-five subjects were included in this investigation as per inclusion and exclusion criteria laid down. Equal numbers of patients were randomly allocated to one of the three treatment groups. Efficacy of three groups [oral ivermectin (Group A), topical permethrin (Group B) and benzyl benzoate (Group C)] of drugs was compared in terms of improvement in clinical grading of disease (%) and improvement in clinical grading of pruritus (%) during follow up visits.Results: Those subjects receiving topical permethrin, at 1st follow up 56.9% showed cure rate which increased to 89.2% at 2nd follow up with respect to clinical improvement in pruritus. Maximum relief in severity of pruritus at the end of 6th week was reported by 58(89.2%) patients receiving group B treatment modality followed by 52 patients (80%) in arm A. Regarding efficacy of three treatment groups in terms of improvement in severity of lesion at the end of 6 weeks, maximum number of patients 57(87.7%), receiving group B treatment reported improvement which is better than other two treatment groups.Conclusions: maximum number of patients receiving topical Permethrin treatment reported improvement better than other Oral Ivermectin therapy and topical benzyl benzoate. Oral ivermectin may serve a good alternative for managing scabies under certain conditions like poor compliance to topical scabicides.
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Rasa Shastra is the pharmaceutical branch of Ayurveda. As like any other medical system, success of Ayurvedic treatment also depends upon quality of medicine prescribed to the patient. The integral part of Rasa Shastra lies in the successful pharmaceutical process. Rasaoushadis are the potent Ayurvedic preparations mainly containing metals and minerals. These Oushadis possess wide range of therapeutic efficacy and are considered superior because of their qualities like small dose, quick action, palatability and longer shelf life. Vatari Guggulu is an important Rasa oushadi described in Bhaishajya Ratnavali - Amavata Adhikarana indicated in Gridhrasi. Vatari Guggulu contains Suddha Gandhaka (Sulphur), Suddha Guggulu (Commiphora mukul), Haritaki (Terminalia chebula Retz), Vibhitaki (Terminalia bellirica Roxb), Amlaki (Emblica officinalis Gaertn), Eranda taila (Ricinus communis Linn). The pharmaceutical procedures adopted in this study are Shodhana, Churna Nirmana and preparation of Vati of Vatari Guggulu. The specific pharmaceutical blend of these contents can result in a more effective formulation. Till now, no research work has been carried out to standardize this formulation. Therefore the present study has been planned to standardize the method of preparation of Vatari Guggulu according to the method explained in the classical literature.
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Objective: To design, synthesize and in vitro antitubercular, antifungal and antioxidant evaluation of some novel mercapto 1, 2, 4–triazole derivatives. Methods: New derivatives were designed by using various software like ACD Lab chemsketch, molinspiration and autodock. Designed molecules are obeying Lipinski’s rule of five and having highest binding score was selected for the synthesis. The synthesized compounds were subjected to TLC, melting point determination, FTIR, 1H NMR, 13C NMR and mass spectral analysis. The newly synthesized compounds were investigated for in vitro antitubercular evaluation by MABA method, antifungal evaluation by cup plate method and antioxidant evaluation by DPPH scavenging assay. Results: A virtual screening was carried out through docking designed compounds into the InhA and CYP-51 binding site to predict if these compounds have an analogous binding mode of the enoyl ACP reductase (InhA) and CYP-51 inhibitors. Three derivatives (4a1, 4a2 and 4a3) were selected for the synthesis with the help of in silico modeling. The selected derivatives were synthesized by a conventional method. All the synthesized compounds showed a characteristic peak in FT IR, 1H and 13C NMR and mass spectroscopic studies. All the selected derivatives showed antitubercular, antifungal and antioxidant activity. Conclusion: The derivatives were synthesized adopting simple and laboratory friendly reaction conditions to give the target compounds in quantitative yields. Newer derivatives possess good antitubercular, antifungal and antioxidant activity.
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INTRODUCTION:We present data from a systematic survey on conflict of interest (COI) disclosure and its interpretation by the doctors participating in continuing medical education (CME).METHODS:A brief 12 question online Google survey with multiple choice options (read, select, and click) was done among Indian practicing doctors using links shared through WhatsApp through the internet over a 72 h period.RESULTS:Of the 386 replies, 373 unique replies were eligible for evaluation. The majority found CME activities beneficial. About 73% of participants would watch out for bias, even if the speaker shows COI disclosure slide. The use of brand/trade names was considered as a flag for bias by the majority. About 99% wanted the speaker to show a final take home message slide. Cross verification of the data presented by comparing to published data was done in more than 75% of instances by only 25% of the participating doctors. A significantly higher number of doctors found bias when CME activities were being organized by the health-care industry as compared to programs of medical bodies/societies/organizations.DISCUSSION:COI considerations are given due to the importance of medical professionals. However, doctors are smart enough to understand the limitations of such disclosures and remain alert to ensure they are not influenced by any bias. Take home message slide gives the presenters opportunity to share their insights and allows the audience to make their own judgment on the impartiality of the data presented. The doctors are aware that bias could be more when CME activities are organized by healthcare industry and take appropriate precautions.CONCLUSION:COI is is given due importance by the medical professionals. COI disclosures are often incomplete. Doctors remain alert to ensure they are not influenced by biased presentations. Concluding take home message slide is unanimously recommended. Presentation bias is more when healthcare industry is directly organizing educational and promotional activities.
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Psoriasis is one of the commonest skin disorders seen in routine clinical scenario, in entire world around 80 million people suffering from psoriasis. Psoriasis is differentiated by patches of abnormal skin. These skin patches are typically red, itchy, and scaly. Psoriasis varies in severity from small, localized patches to complete body coverage. It typically presents as red patches with white scales on top. Areas of the body most commonly affected are the back of the forearms, chin, navel area, and scalp. Diagnosis is typically based on the signs and symptoms. Men and women are affected with equal frequency. The disease may begin at any age, but typically starts in adulthood. Psoriasis is associated with an increased risk of psoriatic arthritis, lymphomas, cardiovascular disease and depression. Psoriatic arthritis affects up to 30 percent of individuals with Psoriasis. It is noted that around 2% of population are touching with Psoriasis. In present study review on Herbs frequently used in treating psoriasis were compiled. The Herbs Nimba, Stri Kutaja, Guduchi, Daruharidra, Bhallataka Haritaki, Aragvadha, Amalaki, Karveera, Saptaparna, Khadira, Vasa, Guggulu, Chitraka & Katuki are reviewed to be having Vata or Kapha balancing properties. The pharmacological studies showing that Nimbidin of Neem having anti psoriatic property, The Methanolic and ethanolic extracts of Stri Kutaja and Guduchi are having anti oxidant and anti psychotic properties which are helpful in reducing the symptoms of psoriasis.
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Lateral periodontal cyst (LPC) is an uncommon type of odontogenic cyst of developmental origin that typically occurs laterally on the root surface of a tooth. They are frequently located in the mandibular premolar area followed by the anterior region of the maxilla. It is usually asymptomatic and is discovered on a routine radiograph. The involved teeth are usually vital. Although the occurrence of lateral periodontal cyst is rare, the precision of its diagnosis is necessary so that the correct treatment can be established. The features of a LPC can be easily confused with a odontogenic keratocyst and radicular cyst
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Frenectomy is one of the common oral surgical procedures performed in Pediatric dentistry. This case report presents the management of a maxillary high labial frenum attachment in a child patient using 810nm Diode laser.
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Multiple supernumerary teeth without any associated syndromes are not common. A mesiodens is a supernumerary tooth located in the palatal midline between the two maxillary central incisors. Mesiodens may give rise to a variety of complications, such as impaction, delayed eruption and ectopic eruption of adjacent teeth.
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Linitus plastica of the stomach is a type of gastric carcinoma usually diagnosed at a late stage due to a lack of early pathognomonic symptoms. A diagnosis is usually by endoscopy and biopsy, however, lack of mucosal involvement leads to false negative reports. Over 50% of patients present with distant metastasis. Metastasis to bladder is rare and synchronous detection of bladder metastasis along with the primary tumor has only been reported in 5 cases in English literature. We present a case where clinical suspicion of a gastric malignancy was made in retrospect after biopsy of bladder tumor confirmed metastasis from a gastrointestinal primary.
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Background: Understanding current perceptions and opinions of medical students regarding learning pharmacology may prove useful in improving the teaching of this discipline. Students’ feedback would probably reveal whether the so-called reforms are acceptable to them and their opinion for the betterment of teaching/learning Pharmacology subject. Aim: The study aimed to determine the opinion of students regarding the teaching of pharmacology, the best way of knowing and retaining the subject and application of the subject in future practice. Methods: The present cross sectional study was carried out by the Department of Pharmacology in collaboration with Medical Education Unit, MSDS Medical College, Fatehgarh among the undergraduate students currently studying the Pharmacology and who were due for appearing in final examination. A 30 item self administered questionnaire was administered to the students in the classrooms just after completion of classes. Time allocated for the completion of the questionnaire was 30 minutes. After compilation of collected data, analysis was done using Statistical Package for Social Sciences, version 21 (IBM, Chicago, USA). Results: Data of 77 study subjects was analyzed. 77% students were in favour of inclusion of real life case studies and their treatment whereas 73% of the students showed interest in Problem Based Learning. Only one student wanted to include more number of seminars. 45% agreed that pharmacology education had given them capacity for self-directed learning whereas 25% of the students reported oppositely. 58% students were in the view of inclusion of recent advances in Pharmacology curriculum. Conclusion: In general students’ perceptions regarding learning pharmacology was observed to be positive. Its need of an hour to address students point of view to make learning the subject from a futuristic practical therapeutic point of view and simultaneously mitigating the general stigma that the study of this essential medical subject is boring.
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Background: It is well-appreciated that many communities in developing countries face severe public-health problems relating to drinking-water. The supply of safe water is important to protect the health of the community people. Aim: The study aimed to evaluate the bacteriological quality of drinking water from various active sources of water utilized in the catchment area of a tertiary care teaching hospital. Material and methods: The present cross sectional study was carried out by the Department of Microbiology and Community Medicine, MSDS Medical College, Fatehgarh during 2013-14. Randomly selected 100 active water sources which were being used for drinking purpose and a fairly good number of people using that water source for drinking purpose were included in the study. National Environmental Engineering Research Institute (NEERI) guidelines for drinking water quality assessment were adopted. Culture and bacteriological tests of drinking water were performed as per standard protocols. After compilation of collected data, analysis was done using Statistical Package for Social Sciences, version 21 (IBM, Chicago, USA). Results: Out of one hundred water samples collected, fifty one, twenty seven and twenty two samples of water were collected from municipal tap water, government hand pump and water cooler respectively. Almost half of the samples were found to be unsatisfactory. E. coli was found to be responsible for 26% of samples whereas Pseudomonas in 20% of collected samples. E. coli and Klebsiella tested positive with Methyl Red whereas Pseudomonas sp. and Klebsiella tested positive with Citrate test reagent. E. coli showed positive result with Indole reagent whereas Klebsiella tested positive with Urease. Regarding mix population organisms, Escherichia coli, Klebsiella Sp. and Pseudomonas Sp. were found to be positive in 3 samples whereas Klebsiella Sp. and Pseudomonas Sp. were found to be positive only in 1 sample Conclusion: The study highlighted unsafe nature of current active sources in the study area with regard to drinking water purpose which are not fit for consumption of water. Surveillance of water sources and regular bacteriological assessment of all water sources for drinking is recommended on regular basis.
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Background: Sinusitis causes inflammation of the middle ear mucosa with increased and persistent mucoid/ mucopurulent discharge and remains as a active mucosal disease. Without correcting the sinusitis the management of ear including surgery has frequently led to failures and poor prognosis Objectives: To establish the role of Sinusitis as Focal sepsis in Chronic Otitis media active mucosal disease. An additional objective was to accentuate the need of proper diagnostic endoscopic evaluation and improvement in middle ear mucosal disease status after functional endoscopic sinus surgery. Material and methods: A total of 50 patients aged 18-49 years with Chronic otitis media active mucosal disease (Tubotympanic type of C.S.O.M.) patients with persistent ear discharge even following culture directed topical and systemic antibiotics with 3 months and more of ear discharge seeking care at Otorhinolaryngology outpatient department were included in this study. Results: Mean age of patients was 42.5 ± 10.6 years. 76% subjects were found having septal deviation/ turbinoseptal deformity which was the most common anatomical variant, 34% had enlarged middle turbinate, 32% had medialised uncinate, 30% had enlarged bulla, 22% had enlarged bulla with prominent agger and 18% had paradoxical middle turbinate. Of these 22 patients had the accessory ostium in the posterior fontanel and 10 patients had accessory ostium in the anterior fontanel. Majority (26, 52%) of subjects had Grade I disease i.e. minimal disease limited to Osteo Meatal Complex followed by Grade II 24% i.e. moderate incomplete opacification of one or more sinuses. On otoendoscopy, 36 patients (72%) had a large central perforation, while 14 patients (28%) had a subtotal central perforation Conclusion: A thorough diagnostic nasal evaluation of all Chronic Otitis Media active mucosal type of patients is essential in comprehensive management of the disease. Deviated nasal septum, enlarged middle turbinate, medialised uncinate predispose to sinusitis.
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Background: Common problems related to self medication are wastage of resources and increasing antimicrobial resistance. They generally entail serious health hazards such as adverse reaction and prolonged suffering. Aim: The study aimed to analyze the pattern, factors influencing and potential adverse effects of self-medication among the undergraduate medical students Material and methods: The present cross sectional study was carried out by the Department of Pharmacology, MSDS Medical College, Fatehgarh among the undergraduate students currently studying in a rural medical school from western Uttar Pradesh. A 25 item self administered questionnaire was administered to the students in the classrooms just after completion of classes. Time allocated for the completion of the questionnaire was 30 minutes. After compilation of collected data, analysis was done using Statistical Package for Social Sciences, version 21 (IBM, Chicago, USA). Results: Data of 256 study subjects was analyzed. Overall prevalence of self medication among study subjects was found to be 71.5% (87.6% among males and 50.5% among females). 82.5% had trust in allopathic medicine system. 81.5% students learnt self medication from doctors prescriptions provided during their prior illness. Regarding categories of drugs commonly self-prescribed, they commonly used antipyretics (81.4%), anti-tussives (72.1%) and analgesics (68.9%). ‘Illness too trivial for consultation’ was the most common (71%) reason for self-medication cited by them. Almost 69% of them were aware of possible adverse effects. 7.7% of them even experienced the side effects of self-medication. Conclusion: The study highlighted growing trend of self-medication among medical students. Policies prohibiting the supply of medicines without a valid prescription should be enforced strictly. A robust monitoring system among the physicians and pharmacists is need of an hour.
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Background: The wide and indiscriminate use of drugs has increased the incidence and the modes of presentation of cutaneous drug reaction. Understanding the nature of ACDRs may help narrow down the search for the offending agent. Aim- The study aimed to evaluate incidence, assessment of causality, severity and preventability of Adverse Cutaneous Drug Reactions as a part of Pharmacovigilance from a rural northern Indian medical school. Material and methods: The current survey was executed by the department of Pharmacology in collaboration with Department of Dermatology, MSDS Medical College, Fatehgarh among 7692 patients attending Dermatology OPD during March-December 2014. CDSCO ADR Reporting Form, WHO causality assessment scale, Hartwig and Siegel’s Assessment scale and Modified Schomock and Thronton’s preventability assessment scale were used as study tools. All the doctors, residents, interns and students were encouraged to notify any suspected ACDRs. Patients were screened and recruited if they presented with visible skin lesions suspected to be drug related. As per Modified Schumock and Thornton Scale, 43.5% of ACDRs were ‘Definitely preventable’ followed by ‘Probably preventable’ (30.4%) and ‘Not preventable’ (26.1%). Results: 23 patients (0.3%) were detected to have one or other type of ACDRs. Fixed drug eruption was most common form (34.8%) of ACDRs followed by Acneform eruption and Urticaria in 21.7% and 13% respectively among study subjects. The most common drugs responsible for ACDRs were prednisolone, betamethasone and isoniazid for Fixed drug eruption, while matronidazole, cotrimoxazole and paracetamol for acneform eruption. Antimicrobials, other steroids and NSAIDs were responsible for other spectrum of ACDRs. On assessment of Causality of ACDRs, it was noted that more than half (52.2%) of them fall under probable category. Severity assessment of ACDRs revealed that majority (65.3%) of them was moderate in nature. Conclusion: Awareness on part of the physician can help in timely detection of cutaneous reactions, thereby restricting damage from them. Pharmacovigilance activity is significantly effective in increasing the reporting of ADRs. Study with long-term follow-up and monitoring of the patients with bigger sample size is warranted.
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AIM: The aim of this study is to assess the efficacy and toxicity of 5‑flurouracil (5‑FU) and cisplatin (PF) versus taxane and cisplatin (TP) as induction chemotherapy in locally advanced head and neck squamous cell cancer. MATERIALS AND METHODS: There were 50 patients in each arm, matched for age, performance state, site and stage of disease. PF arm (cisplatin ‑ 100 mg/m2 D1, 5‑FU ‑ 1000 mg/m2 D1‑D5) TP arm (docetaxel ‑ 75 mg/m2 or paclitaxel ‑ 175 mg/m2 on D1, cisplatin 75 mg/m2 on D2), received once in 3 weeks for 3 cycles. Patients without progressive disease underwent either surgery or chemoradiation. The primary end point was overall response rate (ORR) and secondary endpoint was toxicity. RESULTS: In a total of 100 patients in our study, 44 in PF and 47 in TP arm were evaluable. ORR was 86.6% in PF arm and 82.9% in TP arm (P = 0.71).There were more Grade 3 or 4 events of neutropenia, mucositis (P ≤ 0.05) and myelosuppression diarrhea, febrile neutropenia (P ≥ 0.05) in PF arm compared with TP arm. Post‑chemotherapy hospital admissions due to toxicity were more frequent in PF arm (38.6% vs. 19%), dropout rate due to toxicity (9% vs. 0%) and deaths (6.8% vs. 2.1%) were more common in PF arm compared with TP arm. CONCLUSION: TP induction chemotherapy better tolerated than PF, which has similar efficacy, further multicenter randomized controlled studies; involving a large sample size is needed to confirm our data.
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Why are some dental practices more successful than others? Skill, though undoubtedly important is not the complete answer.Simply put, a successful practice is directly proportional to the number of satisfied patients. And for a patient to be satisfied, it his needs that have to be met – voiced and unvoiced! Thus to be able to deliver effective dental care, needs as perceived by the patient and dentist need to be in sync. But to achieve this first and foremost a dentist must acknowledge the existent gulf that exists between professional and lay perception of needs and then proceed to bridge the gap between the two. This article looks at various ways in which the science of psychology can aid the dentist overcome this ubiquitous impasse. Psychology helps not only in assessing the underlying concerns of a patient but also in addressing them. And this in turn lays the foundation for a long lasting dentist-patient relationship which is what lies at the heart of any successful practice!
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The management of hormone receptor‑positive Her2‑negative breast cancer patients with advanced or metastatic disease is a common problem in India and other countries in this region. This expert group used data from published literature, practical experience, and opinion of a large group of academic oncologists, to arrive at practical consensus recommendations for use by the community oncologists.